WHAT'S NEW AT MEDICC
By Diane Appelbaum, RN, FNP , MS
U.S. Director

MEDICC Donates Textbooks
to Cuban Med Schools

By January 2004, medical schools in all 14 Cuban provinces had received dozens of new textbooks donated by MEDICC. The books-the latest editions of each-cover both basic and clinical sciences, in Spanish and in English. They are destined for the schools' libraries, a resource for professors to update their lectures and classes, and also available to students.

The Latin American Medical School , where 7,000 Latin American, African and U.S. students are now enrolled, was also a recipient; as was the National School of Public Health.

Cuba 's medical libraries are just beginning to recover from the economic crisis of the 1990s, when scarce funds had to be dedicated to medications over textbooks. From 1989 to 1993, while peso expenditures in health actually increased, hard currency available for medical imports dropped from $227 million annually to a mere $63 million. Today's levels are still below the $200 million mark.


	MEDICC International Director Gail Reed visits the library of the Pinar del Rio School of Medicine, where MEDICC-donated textbooks are already on the shelves.

Among the many messages received:

To all those at MEDICC: We received the books you have donated. They are of utmost importance for the academic development of our school. On behalf of our faculty and students, many thanks. Dr. Juan Emilio Caballero, Dean, Cienfuegos School of Medicine.

Thank you, MEDICC! Our professors have already begun using this valuable contribution to our library. Dr. Ana María Díaz Canel, Dean, Salvadore Allende Medical School, Habana.

MEDICC has always been a program close to our hearts, and we're grateful that it has seen fit to make such a needed contribution to our school, and to the students from Cuba and other nationalities studying here with us. Dr. Mirta Sixto, Dean, Pinar del Río School of Medicine.

Dear friends at MEDICC: We received the books you sent our library, and we're very grateful for your assistance and cooperation. Dr. Giselda Sanabria, on behalf of the National School of Public Health.


UCSF leadership group at the Julio Trigo Medical School , Habana, which trains physicians, nurses and other health professionals.

UCSF Center for Health Professions Joins MEDICC in Health Leadership Program

December, 2003, marked the "inaugural cohort" for the MEDICC Faculty-Community Health Leadership Program, this first course a joint effort with the University of California-San Francisco 's Center for Health Professions.

The course, involving some 15 Center fellows, allowed these U.S. health professionals to dialogue with Cuban colleagues on common health problems and approaches to them, as well as to directly observe and assess Cuban models of care and prevention.

Some comments at the end of the course:

There are very deep commonalities in the work I have done in community health over the years, and what Cuba has done. The conditions are different, but it is inspiring to see what can be done in the face of adversity by adhering to humanistic values.

Very high level close-up look at policy issues followed by very up-close, intimate connection with local neighborhood doctors and nurses. Extremely well organized...

I think there is great potential for convergence of movements from different countries around the rubric of quality improvement. That is serving as a point of collaboration in my experience and the same themes resonate in Cuba . The trip with nurses and physicians was good and it was interesting to see the increased emphasis on the MD/RN family med team.

It is affirming of the interdisciplinary work I have the chance to do now - it also reaffirms the use of data for improvement and having clinicians participate in research.

I was not sure what to expect - but I'm so impressed with all aspects of my time in Cuba - the beauty of the surroundings. The warmth and passion of the health professionals and other Cubans. And the richness of the cultures here. This is without a doubt the best week I've spent in a professional setting in the past 2 years! I feel very energized, activated and anxious to share what I've learned, seen and experienced.

.this was one extraordinary experience!

Emory Nursing School Returns to Cuba for MEDICC Practicum

Emory nursing faculty and students returned to Cuba in January, 2004, for a MEDICC Practicum that took them to Havana and Pinar del Río provinces, a course led by Maricela Torres, Associate Professor of Nursing Leadership at the National School of Public Health.

Observational learning in community settings received high marks from the course participants, including the "Santa Maria del Rosario" Healthy Community Project in Havana 's Cotorro Municipality . The maternity ward of the Abel Santamaria Provincial Hospital in Pinar del Rio also provided a look at the Mother and Baby-Friendly Hospital Program, designed to increase breast-feeding among Cuban mothers.

MEDICC Expands Provincial Sites for Electives

Elective enrollment reached a new high last summer, and MEDICC added Cienfuegos' School of Medicine to its provincial calendar. MEDICC's Health Sciences Elective was coordinated there by Professor Emiliano Diez. Students rated especially highly the Seminar with the Cienfuegos Health Tendencies Analysis Unit, the observational learning visit to the Turquino-Manati rural site, and the Lajitas HIV-AIDS Sanatorium.

Comments from students:

"I now see the importance of integrating public health into my medical profession, which I was not aware of before."

"One of the main things I learned is that it takes a strong commitment by the community and the government to improve health and make programs work."

"My time spent in family doctor offices and with epididemiologists in Cuba has prompted me to think of alternative approaches to working with underserved populations in the U.S. in a public health setting. You definitely see how much can be accomplished with limited resources."

The Women's Health Elective offered a week of academic curriculum in Havana , followed by two weeks at the Higher Institute of Medical Sciences in Villa Clara, coordinated by Dr. Aracelys Garcia Gonzalez, Professor and Deputy Director for Academic Affairs. MEDICC students were multidisciplinary, including first and fourth year medical students, nursing, and public health students. One highlight in Villa Clara was a day-long program in communities in the mountains of Jibacoa and Manicaragua, where MEDICC students accompanied family doctors on home visits.

Another was apparently this domino game at the Senior Center ...our student looks a bit worried about her next move.

The Medical Students Clinical Elective had more applicants than in previous years, and unfortunately MEDICC could not accept all those qualified! The provincial site for this elective was the Medical School in Pinar del Rio , which has collaborated with MEDICC for the past three years in providing excellent programs for our students

For the 4 th Year! Student National Medical Association (SNMA)

SNMA is working with MEDICC on its fourth summer short course for members. In 2003, the two-week practicum in July included several days in Santiago de Cuba , with a visit to mountains of the Sierra Maestr. Students commented:

"One of my interests is health policy centering around greater access of health care for poorer people, which tend to be people of color, so it was good for me to visit a country where that is happening."

"This experience has opened the door to me possibly doing some international medicine, which I had never seriously considered until now. This experience will definitely have an impact on the way I hope to practice medicine in the future."

Residency Rotations On the Rise

A total of twenty residents participated in MEDICC residency rotations from January - December, 2003, including eight residents from Yale Department of Family Medicine, which has ongoing collaboration with MEDICC. MEDICC rotations were tailored to the specialties of Family Medicine, Internal Medicine, Pediatrics, Psychiatry, Ob/Gyn and Emergency Medicine. Residency rotations take place in Havana and in Pinar del Rio Province , where residents work closely with Cuban health providers. Comments from returning MEDICC Residents include:

"The MEDICC program has reinforced my desire to work in public health and encourage more integrated approaches to health care delivery."

"As a family medicine resident, seeing the work of family doctors within their community of patients strengthened my commitment to the practice of family medicine."

"Loved the combination elderly day center/child day care here in Havana- what a wonderful example of intergenerational care and sense of community!"

MEDICC Exhibits at Conferences in 2003

MEDICC programs were publicized at the Society for Teachers of Family Medicine National Conference in Atlanta (September, 2003), and I offered more details at their international health workshop: Teaching Family Medicine Around the World: Lessons From the Field. MEDICC's exhibit was also prominent at the American Association of Medical Colleges (AAMC) conference in Washington in early November, and at the American Public Health Association (APHA) convention the same month in San Francisco.

WHAT'S NEW AT MEDICC By Diane Appelbaum, RN, FNP , MS U.S. Director